Now that my daughter’s on a pump and I look at all of the advantages, I think, ‘Wow.’

Tonya Wanamaker

To pump or not to pump. That is the question when it comes to type 1 diabetes. A few others: Are pens better than syringes? Should I bother with a continuous glucose monitor (CGM)? And do I really need a pump and a CGM? There’s no right or wrong answer. As the following three women show, a host of factors play a role in the decision process. For Diana Carter, daughter Tonya Wanamaker, and granddaughter Sierra Wanamaker—all of whom have type 1 diabetes—the choices often come down to lifestyle and life stage.

Diana Carter, 61

Diana Carter

Photograph by John Emerson

If anyone understands the beauty of progress, it’s Diana Carter, who remembers the less advanced techniques she used to manage her type 1 diabetes after being diagnosed at age 26. Back then, checking her glucose level meant using a urine test kit—and carting it with her whenever she went out. Carter relied on insulin vials and syringes with needles so large the shots were painful. And even when blood glucose meters hit the market, Carter says their bulky size, slow response time, and large blood sample size requirements made them a far cry from the model she uses today.

Carter has since swapped her vials and syringes for long-acting and rapid-acting insulin pens. “You don’t have to carry a bottle and needles. You don’t have to load your insulin into your [syringe],” she says. “It’s quicker and it doesn’t hurt as much. You just dial the dose and go.” Carter also appreciates how dialing a dose makes it easier to deliver the right amount of insulin.

But her preference for pens over vials and syringes isn’t just practical. It hits on emotional issues many people with diabetes face. “If you get this needle out, people are looking at you strange,” Carter says. “But the average person doesn’t have a clue what the pen is. It’s more private.”

Though Carter once considered going on an insulin pump—she even took a class on pumping—she’s happy with her current treatment method. “When I took the class, it kind of scared me away. I was like, ‘I’m not going to be able to learn all this,’ ” she says. “I think [a pump] is too complicated for me.”

That said, she’s considering reevaluating that plan. “I feel I need to do some updating, and I’m kind of ready to do that at this stage in my life,” Carter says. What she’s not interested in updating is her blood glucose monitoring method. She won’t be supplementing her blood glucose meter with a continuous glucose monitor (CGM) anytime soon. “I thought about [getting a CGM], but I talked to people who have it and they said it hasn’t worked well,” Carter says. She worries about false alarms at all hours of the day and night.

She may not be ready to fully embrace all forms of diabetes technology in her life, but Carter appreciates the advancements that have been made since she was diagnosed with diabetes 35 years ago. “Thank goodness things have progressed a little since then,” she says.

TIP: Can’t remember whether you’ve taken your injection of long-acting insulin? Follow Diana Carter’s lead: Buy a days-of-the-week pill container, and at the start of the week fill each slot with an unused pen needle. Use the needle for that day’s injection. Next time your memory fails, check the day’s box. If there’s a needle, you haven’t taken your insulin yet.

Tonya Wanamaker, 41

Tonya Wanamaker

Photograph by John Emerson

Tonya Wanamaker has had a rocky relationship with diabetes. Diagnosed with type 2 in high school, Wanamaker rebelled against the oral medications she was prescribed and the blood glucose checks she was ordered to perform, refusing to carry her meter with her and rarely checking her glucose level.

When she got pregnant at 21, diabetes became Wanamaker’s priority. Her family doctor prescribed NPH and Regular insulins in an attempt to lower her high A1C. But Wanamaker struggled with hypoglycemia. Her job as an X-ray technician came with unpredictable lunch and break times, and Wanamaker spent plenty of time in the bathroom, desperately eating in secret so no one would know about her diabetes, which she feared would put her job in jeopardy.

Scared by the two serious lows she had while pregnant, one of which left her passed out in a field—across from a candy store, no less—Wanamaker began keeping her blood glucose high. An emergency room trip during diabetic ketoacidosis was Wanamaker’s tipping point, and she went to an endocrinologist for the first time.

His diagnosis: Wanamaker had type 1 diabetes all along. The Rx: an insulin pump. The device transformed her diabetes management. “I was completely under control then,” she says. “I could go right from the ER to lunch. I didn’t have to worry about grabbing my purse with my pens. When I was on the pump, there was no certain time I had to eat whatsoever.”

Even better: Wanamaker was able to avoid frequent low blood glucose. For five years and through another pregnancy, Wanamaker successfully managed her blood glucose using an insulin pump. Until her allergy hit.

A year after her daughter, Sierra, was born, Wanamaker developed a severe allergy to the adhesive that stuck her pump’s infusion set to her body. No matter how many types of tape she tried and regardless of how often she changed her infusion set site, her skin broke out in blisters and hives. And so after five years, she returned to insulin pens.

“Now that my daughter’s on a pump and I look at all of the advantages, I think, ‘Wow,’ ” Wanamaker says. She cites dual-wave boluses, which release insulin immediately and also deliver insulin evenly over a longer period of time for high-fat meals, which delay carbohydrate absorption. “Me? If I eat pizza, I have to test a lot.”

That said, she’s aware of an insulin pump’s downsides: “If it stops working, you don’t have any insulin,” she says, mentioning the time Sierra’s cannula pulled away from her skin inside the sealed tape. When her daughter’s blood glucose read 400 mg/dl, Wanamaker knew there was a problem.

Wanamaker’s insulin delivery method of choice: pens, with which she says she can get a more accurate dose thanks to the dial-to-dose feature. “When I first started, I was on syringes,” she says. “That was a pain to draw that up at work.”

But insulin pens and her trusted meter are about the only tech Wanamaker’s willing to use—even if she wishes she could try using a pump again. And while her doctor broached the topic of CGMs, they decided together that the devices, which also use adhesive and tape to stick to the skin, might not be a good fit considering Wanamaker’s allergy.

Though her experience with type 1 diabetes hasn’t been easy, Wanamaker says the lessons she’s learned over her decades with diabetes have been invaluable for her as a mother. “We have each other,” she says. “If my daughter was going to get some [disease], I’m glad it was diabetes because I know that.”

TIP: Store-bought glucose gels can be expensive, so Tonya Wanamaker has found a cheaper alternative: liquid taffy, which comes in a resealable tube that contains 54 grams of carbohydrate, enough for multiple doses. It’s Wanamaker’s pick for water sports because the tube is waterproof.

Sierra Wanamaker, 14

Sierra Wanamaker

Photograph by John Emerson

When Sierra Wanamaker was diagnosed with type 1 diabetes three years ago, she may not have known much about the disease, but she had a strong team on her side—namely, her mother and grandmother, who had both been living with diabetes for decades. And while she followed in their footsteps by beginning insulin injections with a vial and syringe, Sierra soon adopted devices that simplified her diabetes management. Nearly a year after her diagnosis, she switched to pens, which she says make dosing insulin a cinch. The year after that she started on an insulin pump.

She successfully wears her pump during her field hockey, basketball, and softball games. She troubleshoots slipping infusion sets by using adhesive that keeps her set firmly in place. Her mom sewed a pump pocket into Sierra’s sports bra so the device would be safe during competition.

But what she loves the most about her pump is the independence it gives her. “In high school, they don’t baby you. You’re a grown-up now,” she says. “You have to take responsibility. That’s a lot of what they’re teaching us this year.” And so instead of asking the school nurse to give her insulin injections, Sierra does it herself: “With the pump, I can just pull it out of my pocket, type the carbs in, and go.”

She also enjoys the flexibility it provides. “I don’t have to wait for a shot if I want to eat something right away,” she says. “It makes me have more freedom so I feel like a normal teenager.” As a freshman adjusting to high school life, feeling like a regular teen is important to Sierra. That’s part of the reason she doesn’t want to try a CGM: “I don’t need something extra on my body 24–7,” she says. “If I wear fitted shirts, there’d be two lumps on me.”

Sierra’s also able to express her personality through her pump, a feature syringes and pens don’t offer. Right now, her pump wears a “skin” featuring singer Cody Simpson, which inspires Sierra to manage her diabetes.

TIP: Newly diagnosed teens and children may jump at the chance to wear a pump, but Sierra Wanamaker says it’s best to get used to insulin dosing using syringes and pens first.